Dental problems hurting soldiers' readiness

Within Washington's Army National Guard, they were known as the "Denture Dozen," a group of men released from active duty during the Iraq call-up because their teeth barely held in their mouths.

They were the most egregious examples of a trend that military planners said complicated the massive deployment of the state's citizen soldiers last year.

About 30 percent of the 4,500 guardsmen called to active duty were discovered to have dental problems so severe they were unfit to go overseas.

It took a Herculean effort to get soldiers into dentist chairs before the 81st Brigade Combat Team dispatched to Iraq in March 2004. All but the Denture Dozen made it on time, and the last units in the 81st returned home two months ago.

The problem, Washington National Guard officials said, was simple: Many guardsmen lacked dental insurance and were unable or unwilling to pay for care.

"We spend an awful lot of money making sure the MI-AI (tank) is ready to be deployed. We spend absolutely nothing on physical readiness of soldiers prior to mobilization," said Maj. Gen. Timothy Lowenberg, head of the Washington National Guard. "It is a significant point of failure."

It also is a national problem: The Army discovered 20 percent of its citizen soldiers arrived at mobilization sites with dental conditions that made them nondeployable.

On Wednesday, the House Armed Services Committee passed a $441 billion defense bill that included a provision to provide permanent, government-paid health and dental insurance to National Guard members before they mobilize.

Estimated cost: $3.8 billion over 5 years.

Whether the provision will survive when the final bill goes to the House floor next week remains to be seen.

But the committee noted it was "concerned that improvements are needed in addressing the dental needs of the reserve components," and Congress is almost certain to examine ways to improve the readiness of the nation's part-time soldiers.

Burden falls on soldiers

The Army discovered during the Persian Gulf War mobilizations of 1990-91 that significant numbers of reservists could not be deployed due to poor dental status, and the Army began collecting information on the health of non-active duty personnel. Active-duty soldiers are provided dental care at little or no cost.

Still, most of the burden of maintaining good teeth rests on individual soldiers.

If they don't have employer-provided dental insurance, guardsmen can enroll in a government plan that costs about $10 monthly.

The fees pay for annual examinations and there is a sliding scale for deductibles on major dental work, taking into account the specific procedure and soldier's rank.

Employment statistics are unavailable for the National Guard, but military officials say some soldiers survive exclusively on the military's monthly paycheck of $125 to $500.

That makes dental insurance a luxury they often can't afford. In an interview with National Guard & Defense Review Magazine, Lowenberg noted 40 percent of Guard members nationally have no dental plan.

Last year, the Army established new readiness guidelines, including a goal that 95 percent of mobilized soldiers would show up with teeth healthy enough to deploy.

The guidelines reiterated a previous policy requiring soldiers to submit a form verifying they had an annual dental evaluation from a civilian dentist.

According to the regulations, following up on the paperwork was an officer's duty: "The unit commander is responsible for the dental readiness of the assigned soldiers."

In a 2003 report, the General Accounting Office, Congress' investigative arm, discovered the Army rarely checked whether the required exams had been performed.

That revelation came as no surprise to Col. Robert Carter.

An Army dentist at Fort Lewis, Carter knew he was going to be busy when the 81st Brigade was called to active duty on Nov. 15, 2003.

Carter served during the Persian Gulf War, and he saw firsthand what happened when thousands of citizens suddenly showed up.

"We were prepared for the worst, prepared to work nights and weekends," he said. "We knew they were coming."

Root canals and fillings

When National Guard troops are activated, they go through examinations to make sure they are physically fit.

The average age in the 81st Brigade is 31, and medical ailments weren't much of an issue.

Dental problems were another story.

"You got 32 teeth. You got 32 times the chance (for trouble)," Carter said.

In the Army, a dental Classification 3 means soldiers will likely experience problems within a year, and therefore cannot be deployed in a combat zone.

The Army doesn't want distracted soldiers suffering from toothaches. Nor does it want to remove soldiers from their units during operations.

About 1,200 soldiers in the 81st Brigade were determined to be Class 3.

Once a guardsman is activated, health care is paid by the military, and most of the soldiers in the 81st were treated at Fort Lewis.

Carter, the Army dentist, said it often took multiple visits to heal his patients. He worked nights and weekends, performing root canals, filling cavities and extracting teeth.

Some of the men were in such bad shape, Army dentists created computer slides of their patients to show students some of the worst cases they'd ever seen.

Lack of access to a dentist, insurance and financial resources were the main reasons why soldiers let their oral hygiene slip, Carter said.

Although the vast majority of Class 3 soldiers shipped out to Iraq on time, dental issues often scrambled tight training schedules.

A soldier in the dentist office, said Gen. Gordon Toney, commander of the Washington Army National Guard, was "not on the rifle range that day."

Free care for guardsmen?

When the first waves of National Guard units were activated across the nation in 2003, it soon became clear the dental-readiness problems that cropped up in the Persian Gulf War had not eased.

As part of the supplemental war budget in 2004, Congress made it possible for Guard soldiers to receive free dental care when placed on alert status, which typically occurs several weeks before troops are activated.

The rule change was intended to provide a short period of additional dental care to help reduce the number of Class 3 soldiers.

But there is an ongoing debate on Capitol Hill about whether the changes go far enough.

Democrats on the House Armed Services Committee led a successful charge to add permanent health and dental benefits to the National Guard in the 2006 defense bill.

The provision's sponsor, Rep. Gene Taylor, D-Miss., said it was an issue of fairness. "The insurgents in Iraq don't differentiate between reserve soldiers and active-duty soldiers," he said.

Besides the expense, there are other reasons why lawmakers and military officials are hesitant to extend dental benefits to Guard members.

Free health care is a big incentive to join the active-duty Army. Would extending similar benefits to the National Guard make the regular Army less attractive?

Would citizen soldiers swamp the existing Army health-care system, diminishing quality of care for everybody?

Would small employers aggressively seek Guard members to reduce their health-care costs?

Those issues continue to be examined by Congress.

"There is a clear recognition of a problem," said Rep. Rick Larsen, D-Lake Stevens, who serves on the House Armed Services Committee.

"Most people don't think of it, but when you mobilize 5,000 folks, it isn't just a matter of armored Humvees. It's a matter of: Are these people ready to engage the enemy?"

Meanwhile, Toney said the Washington Army National Guard is considering deploying mobile military dental vans to follow troops during their weekend drills, showing up at rifle ranges to examine soldiers while they wait their turn.

And the Guard is updating computer networks to better track troops' dental records.

Despite the difficulties, Toney noted that the Washington Army National Guard activated faster than anytime since World War II, and most soldiers shipped to Iraq on time.

"As we ramped up for a major deployment, we found dental was an issue," Toney said. "But it's also a good-news story because we ramped up some support."

Alex Fryer: 206-464-8124 or afryer@seattletimes.com